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Permanent Catheter for Person with Dementia
Anja5
Posted: Wednesday, June 28, 2017 6:05 AM
Joined: 6/27/2017
Posts: 1


My father is 85 years old, in the middle stage of Alzheimers, lives in a nursing home, and has been a bit incontinent lately. Now hospitalized for an infection (urinary track?) the placement of a permanent catheter is discussed. What are your experiences with a person with a permanent catheter? 'Understanding' it, tolerating it, infection risk? Thanks for your help!
MPSunshine
Posted: Wednesday, June 28, 2017 6:22 AM
Joined: 5/21/2016
Posts: 2011


My dad had an indwelling foley catheter for over a year due to large bladder stones and an enlarged prostate that blocked urine flow. Other catheter systems were suggested to him (super-pubic catheter, nephrostomy tubes) but rejected by him, since he was able to emit a small bit of urine and he did not want more holes created in his body. He was on hospice care so the replacement of the catheter was based on his symptoms. Symptoms that would require replacing the catheter would include symptoms of blockage such as reduced urine flow, cloudy and then potentially mucous filled urine, bloody urine, and symptoms of a urinary tract infection such as pain in the back (kidney area), fever, confusion. My understanding is that generally urologists will replace indwelling catheters about every 4-6 weeks in order to reduce infection, but they do not like to leave patients with them because of the potential for infection traveling from the sterile bag up the tube into the bladder. My dad never liked the catheter but he liked being alive. When it was explained to him that backed up urine would create damaged kidneys and heart damage -- which is what led him to the catheter to begin with, then he would accept that. He would take a pain killer and muscle relaxant one half hour prior to the catheter being replaced. Clean intermittent catheterization is possibly another option for your dad but probably was not suggested because it does require adhering to a schedule and following a clean protocol for keeping the bladder empty.
Jo C.
Posted: Wednesday, June 28, 2017 7:30 AM
Joined: 12/9/2011
Posts: 13332


Hello Anja5, and a warm welcome to you.   I am an RN whose mother had Frontotemporal Dementia and whose step-dad, MIL and GMIL all had Alzheimer's Disease.

You are a good advocate for your father and are trying to do what is best for him.  I was wondering, who brought up or requested the indwelling urinary catheter?  If it is simply for staff convenience, and there is no physical need to assist voiding because the person cannot void, that is considered a negative reason for catheterization.

The procedure itself is not comfortable, especially for a person with dementia who may see this as a threat to themselves.  Also, just the mere act of inserting a catheter no matter how the RN uses good technique, causes risk of infection and an indwelling catheter is also a high risk for recurring infections.  The catheter has to be replaced from time to time and this again causes the trauma with the necessary procedure and risk.  When a catheter has been inserted, the nurse uses a syringe with water into a port to inflate a "balloon" so the catheter is held in place and does not slide out.  Intermittent catheterization, especially in a patient with dementia would be traumatizing as well as again causing potential for infection.  This is usually reserved for those who are unable to void and then it is usually done about six times a day.

Some of the difficulties in having a catheter is that it is not consistently comfortable for most, and there can be "spasms," and the person with the catheter can feel the catheter's presence.   My personal experience is that so many patients with dementia with indwelling catheters actually pull them out, inflated balloon and all.   Truly.   Then that leads to someone having to somehow restrain the person's ability to do this and I have seen restraining gloves put on a person and that is not good practice.

There are also external catheters.  A condom-like sheath is placed on the penis.  There is a tube leading from the bottom of the sheath, it leads to a leg bag.  The bag collection bag is strapped to the person's calf.  This device comes with it's own problem issues of the sheath falling off, leakage and no tolerance by the patient as well as staff remembering to empty the small collection bag multiple times a day.  These devices, for most, are not highly successsful.

The best approach would be for staff to assist your father to the bathroom to void every two hours and provide him with men's disposable incontinence briefs or if it is just leakage and not a total void, there are incontinence pads made for the male anatomy that fit inside briefs.  The voiding every two hours should be put in writing into the patient care plan and monitored by the supervising nurse.

This is a challenge and I so hope that this problem can be met with special briefs, (some are designed to look just like regular briefs), and assisting him to the bathroom more frequently.

Best wishes coming your way,

J.


Mom's Baby
Posted: Wednesday, June 28, 2017 10:40 AM
Joined: 12/19/2011
Posts: 1176


Hi Anja, I can't speak to the medical side of a person having a permanent catheter, but there was a lady named Florence who resided at my mom's memory care who had one of these. She seemed to do fine with it medically, the hard part was that she never remembered she HAD a catheter. She was pretty advanced in her dementia, immobile, wheelchair-bound, but she could still talk, and she would constantly ask everyone around her to help her get to the bathroom because she "had to go." 

The first time she asked me to help her get to the bathroom, I asked one of the aides to assist her, and they whispered, "She has a catheter, she doesn't need to go to the bathroom." So from then on, I'd have to tell Florence, "You have a catheter" or ignore her, which was hard. She'd actually get mad because I'd focus on my mom and not on answering her question. To be clear, I'd always answer her, but then she'd repeat herself again and again.

So, just something to think about in addition to the medical side. 


Sather56
Posted: Wednesday, June 28, 2017 12:15 PM
Joined: 5/30/2016
Posts: 573


My FIL, Dad, asked his urologist about using a catheter, during his early stages of dementia. The urologist told him and my DH that unless he was unable to urinate, he would not recommend it. He told my DH that as the disease progressed, he could do himself more harm than good. Dad isn't good with his hygiene and that would pose problems.
Iris L.
Posted: Wednesday, June 28, 2017 12:34 PM
Joined: 12/15/2011
Posts: 18248


The risk of infection is increased with an indwelling catheter.  What is the purpose of the indwelling catheter?  Is it for convenience, to avoid toileting or using disposable undergarments?  Is there an obstruction?  Is the patient uncircumcised?  Hygiene of the foreskin is important.


Iris L.

BillBRNC
Posted: Wednesday, June 28, 2017 6:06 PM
Joined: 12/2/2015
Posts: 1018


Many years ago, my mother had Alzheimer's. She had some surgery that resulted in her having a catheter. First, she went downhill fast due to the surgical procedure and the hospitalization. I was against the surgery, but my brother and my wife were in favor of it. Anyway, my mom didn't know what it was. We would explain, then 5 seconds later she would ask what it was. At night and sometimes during the day, she would continually pull it out, which caused much problems. Personally, I wouldn't do it, nor would I put someone through surgery if they are fairly far along with dementia. Just my two cents. By way, I have Dementia with Lewy Bodies and Alz, and my Advanced Directive states clearly that these things should not be done under any set of circumstances, and my wife and son know that I will come back to haunt them if they go against my wishes on this. Just saying.
mawvkysc
Posted: Thursday, June 29, 2017 9:36 PM
Joined: 1/3/2013
Posts: 50


I just posted a question related to this. The post title is Cipro. My FIL is on a permanent In -dwelling catheter because he can't void. His bladder just fills and fills and would eventually burst. He is in end stage vascular dementia. He is past the stage of pulling it out. It at times seems to cause him discomfort. He keeps getting UTIs. The dr felt that using the other kind of catheter that you use 3-6 times a day would pose more infection and trauma risk. I would not reccomend it unless absolutely necessary. But yes it is convenient, except in our case 1/month getting him to the dr office for the change out.
Michael Ellenbogen
Posted: Friday, June 30, 2017 11:56 AM
Joined: 11/30/2011
Posts: 4346


I would not subject anyone to that as it is painful and the risk of infection is very high if you keep it in a long time.


MPSunshine
Posted: Friday, June 30, 2017 4:01 PM
Joined: 5/21/2016
Posts: 2011


Anja5, the original poster, has not stopped back in. However, I would hope that people posting their reactions here would note that catheterization would never be done by responsible medical personnel unless absolutely medically necessary, absolutely NOT for convenience of staff. 

Persons catheterized (like my dad was) chose catheterization over death. For my dad the cascading effect of urine filling his bladder, then backing up into his kidneys and then shutting down his heart was not his desired fate. At that point in his life, he had a choice of whether to put up with catheterization, or die from sepsis or a heart attack. He chose life. Catheterization is not necessarily painful -- there may be discomfort because of the reason for catheterization, say, if there is a large stone blocking the ureter, or if there is an extremely enlarged prostate, both were the case with my dad.

I do hope Anja5's loved one is getting the attention they deserve and that this is not just an incontinence issue -- Anja5 stated he was only a "bit incontinent," and in this case any and all other ways (wearing adult underwear, trying on the toilet every two hours) should be tried first. No way should catheterization ever be considered for convenience of staff. That is just wrong.

My reason for posting is to clear up the misconceptions.